Inspector: LORI JAMES, ENVIRONMENTAL SPECIALIST II
Risk-Based Violations
Retail: Multiple canned food items including Vienna sausages severely dented along seam.
COS: Items were voluntarily discarded. Stop Sale Order and Release issued, see order.
Retail - Bloated package of hot dog and mold-like particles on smoked meat pieces found
inside the open-air walk cooler. COS, items were voluntarily discarded. Stop Sale Order and Release
issued, see order. Retail - Grain insects found inside package of rice on retail. COS: Items were voluntarily
discarded. Stop Sale Order and Release issued, see order.
x
Retail - Raw salted cod stored over ready to eat beef smoked sausages inside the open-air
wall cooler. COS: Cod moved to proper location.
x
Backroom - Heavy accumulation of black mold-like substance around ice chute and inside
areas of ice machine. Stop Use Order issued, see order.
Kitchen - Old food residue encrusted on the deli-meat slicer blade, guard, and food holding
attachment. COS: Slicer was wash and sanitized.
Kitchen - Bacon, sausage, grits, fish, eggs; scrambled and hard boiled, and pork chops
inside hot case found with internal temperatures of 104-129 degree F when checked with an accurate
probe thermometer. COS: Items were voluntarily discarded. Stop Sale Order and Release issued, see
order.
x
Print Date: 9/9/2026
Page 2 of 5
20
P
Citation Description: Cold held time/temperature control for safety food not maintained at 41°F or below.
3-501.16(A)(2) P
Observation: Retail - Milk, beef stew, rice, and raw eggs inside walk-in cooler found with internal
temperatures of 47-49 degrees F. Retail - Hot dogs, eggs, lunch kits, sour cream, butter, smoked meats,
cream cheese, sausages, pork crackling, salted pollock, smoked sausages inside open-air wall cooler
found with internal temperatures of 47-51 degrees F. COS: items were voluntarily discarded and verified.
Stop Sale Orders and Release issued, see orders.
x
Person in charge was unable to correctly respond to questions related to food borne
diseases and reporting responsibilities. Employee Health Guide provided.
o
Person in charge could not show a verifiable manner for which employees are informed of
reporting responsibilities. Employee Reporting Agreement provided.
Kitchen - Raw eggs placed on preparation table next to kitchen stove measured an internal
temperature of 62 *F. COS, eggs were voluntarily discarded and verified. Stop Sale Order and Release
issued, see order.
x
Kitchen - No date mark on the Souse deli meat stored in the reach-in deli cold unit and
manager did not know when package was opened. COS: Item was voluntarily discarded. Stop Sale Order
and Release was issued, see order.
x
No written procedures available. Guidance document provided.
Kitchen - Employee water bottle stored on preparation table next stove.
Backroom - No hand drying device provided at hand sink next to three- compartment sink or
at sink inside employee restroom. Kitchen - No hand drying device provided at hand sink next to kitchen
stove. COS: Paper towels provided at each sink.
Backroom - Long handle metal spoon inside hand sink and basin. COS: Item moved to
three-compartment sink.
Good Retail Practice Violations
Kitchen: No ambient thermometer inside hot hold unit and meat display case.
Retail: Bags of store packaged ice in cooler next to walk-in entrance not labeled with source
information. COS: Source information added.
Y
x
Retail: Condiment bottles on table by microwave not labeled with common name.
Kitchen: Utensils and knives stored inside dirty plastic container on preparation table. Person
in charge moved to three-compartment sink.
Meat room area: White cutting board on preparation table found heavily scored with black
mold-like substance. Person in charge moved the board to three-compartment sink.
Retail: Walk-in cooler found with ambient temperature of 48 degrees F and open air wall
cooler found with ambient temperature of 49 degrees F and unable to maintain temperature controlled
foods at 41 degrees F or less. Stop Orders issued, see orders. Kitchen - Deli meat cooler sliding door
broken. Backroom - Ice machine door broken and held with duct tape.
Ware Washing area: Black mold-like substance on walls of compartments.
Retail: Accumulation of dust and dirt on metal retail shelves throughout store. Kitchen - Deli
meat cooler with mold-like residue on sliding doors.
Ware wash area: Pipe from three-compartment sink leaking onto floor.
Backroom: doors are not self-closing.
Outside: Dumpster lids left open.
Outside: Dumpster placed on dirt.
Backroom: wet mop stored in mop bucket stored next to ice machine.
Kitchen: Broken and missing floor tiles in area in front of entrance to back room. Broken
ceiling tile about grill.
Kitchen: Employee back pack stored with food items on prep table next to grill.
Stop-Sale Orders & Supplemental Actions
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Approved Source: Food in good condition, safe and unadulterated.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Approved Source: Food in good condition, safe and unadulterated.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Approved Source: Food in good condition, safe and unadulterated.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Time/Temperature Control for Safety Food: Proper cold holding temperatures.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Time/Temperature Control for Safety Food: Proper cold holding temperatures.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Time/Temperature Control for Safety Food: Proper cold holding temperatures.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Time/Temperature Control for Safety Food: Proper hot holding temperatures.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500; FAC 5K-4 Violation of Florida Food Law.* Time/Temperature Control for Safety Food: Proper date marking
and disposition.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: .
STOP USE ORDER
Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Protection From Contamination: Food-contact surfaces: cleaned
and sanitized.
Comments: To request a Food Safety Inspector visit for written release when corrections have been made for request release of equipment,
contact the Business Center at (850) 245-5520 or
[email protected].
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP USE ORDER
Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Utensils, Equipment and Vending: Food and nonfood-contact
surfaces cleanable, properly designed, constructed, and used.
Comments: To request a Food Safety Inspector visit for written release when corrections have been made for request release of equipment,
contact the Business Center at (850) 245-5520 or
[email protected].
Print Date: 9/9/2026
Page 5 of 7
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP USE ORDER
Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Utensils, Equipment and Vending: Food and nonfood-contact
surfaces cleanable, properly designed, constructed, and used.
Comments: To request a Food Safety Inspector visit for written release when corrections have been made for request release of equipment,
contact the Business Center at (850) 245-5520 or
[email protected].
Print Date: 9/9/2026
Page 6 of 7
When the department or its duly authorized agent finds, or has probable cause to believe, that any food or food-processing equipment is in
violation of this chapter or any rule adopted under this chapter so as to be dangerous, unwholesome, fraudulent, or insanitary within the meaning
of this chapter, an agent of the department may issue and enforce a stop-sale, stop-use, removal, or hold order, which order gives notice that
such article or processing equipment is, or is suspected of being, in violation and has been detained or embargoed and which order warns all
persons not to remove, use, or dispose of such article or processing equipment by sale or otherwise until permission for removal, use, or disposal
is given by the department or the court. It is unlawful for any person to remove, use, or dispose of such detained or embargoed article or
processing equipment by sale or otherwise without such permission in accordance with 500.172 (1) Florida Statutes.
Release - Other
The Food Establishment voluntarily agrees to release the products listed in the stop-sale order(s) on page(s) 1, 2, 3, 4 for destruction. The Food
Establishment will not hold the Department liable for any lost revenue or income as a result of the destruction.
___________________________________
Signature of Food Establishment Representative
AN ADMINISTRATIVE HEARING IS AVAILABLE FOR ALL ORDERS, NOTICES, AND REPORTS IN THIS
SUPPLEMENTAL REPORT
If you wish to contest the Department's action, you have the right to request an administrative hearing to be conducted in accordance with
Sections 120.569 and 120.57, Florida Statutes and to be represented by counsel or other qualified representative. Your request for hearing must
contain:
1. Your name, address, and telephone number, and facsimile number (if any).
2. The name, address, and telephone number, and facsimile number of your attorney or qualified representative (if any) upon whom service of
pleadings and other papers shall be made.
3. A statement that you are requesting an administrative hearing and dispute the material facts alleged by the department, in which case you must
identify the material facts that are in dispute (formal hearing), or that you request an administrative hearing and that you do not dispute the facts
alleged by the department (informal hearing).
4. A statement of when (date) you received the Notice and the file number of this Notice.
Your request for a hearing must be received at the address shown on this Notice within twenty-one (21) days of receipt of this
Notice. If you fail to obtain a Release from this Notice or fail to request an administrative hearing within the twenty-one (21) day
deadline you waive your right to a hearing and the Department may enter a Final Order imposing up to the maximum penalties as authorized by
Florida Law.
HEARING WAIVER AND WAIVER OF RIGHTS
Hasan Khan
I, _____________________________________________________ the person in charge of COMMUNITY FOOD STORE #9 hereby waive a
notice and a hearing as provided in Chapter 120, Florida Statutes and waive all rights as provided on the last page of this report.
____________________________________________
(Signature)
ACKNOWLEDGEMENT
I acknowledge receipt of a copy of this document.
(Signature of FDACS Representative)
(Signature of Representative)
LORI JAMES, ENVIRONMENTAL SPECIALIST II
HASAN KHAN, MANAGER
Print Name and Title
FDACS-14325 Rev. 07/13
LUIS LOPEZ, SANITATION AND SAFETY SPECIALIST
Print Date: 9/9/2026
Page 7 of 7
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight: